Bowel, Bladder Problems Linked to Higher Levels of Fatigue and Disability, Study Reports
Bladder and bowel problems, such as constipation and fecal incontinence, are associated with a higher level of fatigue in people with multiple sclerosis (MS), according to a study in Australia.
The findings also showed that greater fatigue and experiencing bowel and bladder problems are associated with a higher level of disability.
The research, “The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience,” was published in the journal PLOS ONE.
Bladder or bowel problems are frequent in people with MS, and may manifest as urinary incontinence or retention, slow intestinal transit, and chronic constipation. It is estimated that more than 50% of MS patients experience these problems.
However, research on bowel dysfunction specifically, and on whether bladder and bowel symptoms are associated with fatigue and disability in MS, remain scarce.
Now, a team at Neuroscience Research Australia conducted a single-center study to address these gaps. Questionnaires on bowel, bladder, and fatigue symptoms were distributed to adults with MS who visited the MS Studdy Center in Sydney between March and October 2018.
Specifically, the Actionable Bladder Symptom Screening Tool of bladder symptoms in MS was used to assess urinary urgency, leakage and frequency, excessive urination at night (nocturia), and the psychosocial impact of bladder problems. The Rome III criterion was used to determine the frequency of constipation, while the Revised Faecal Incontinence Scale analyzed the severity of fecal incontinence and stool leakage.
In turn, the Modified Fatigue Impact Scale was used to assess fatigue symptoms in the four weeks prior to completing the questionnaire.
A total of 136 people with MS completed the questionnaires — 90 women, mean age 56.1 years, mean 18.2 years since diagnosis. Among the participants, 44 had relapsing-remitting MS, 58 secondary progressive disease, and 27 primary progressive MS. Seven patients had unknown MS type.
Most responders (72.1%) had an Expanded Disability Status Scale (EDSS) score of 5 or higher, indicating moderate disability.
Results showed that, among the 117 patients without a permanent indwelling catheter, 87 (74.4%) had significant bladder dysfunction. Adding the 18 patients with a permanent catheter — often used following the failure of conservative and non-invasive strategies — meant that 105 (77.8%) of 135 participants had bladder problems.
Urge incontinence was the most frequent form of urinary incontinence, occurring in 71.1% of participants, with stress incontinence found in 14.4%.
The results also showed that almost half (48.9%; 66 patients) of the respondents met at least two criteria for functional constipation. A total 31.9% (43 patients) had fecal incontinence.
A subsequent analysis revealed that a higher level of disability was associated with greater severity of bladder problems and of fecal incontinence, as well as with the fatigue score. Having a higher level of disability also correlated with experiencing functional constipation. As an example, every 1-point increase in the EDSS score increased the risk of constipation by 16% in a person aged 20.
After accounting for both age and level of disability, the data showed that greater fatigue corresponded to greater severity of bladder dysfunction and of fecal incontinence. A similar association was found between fatigue and constipation. In a patient with an EDSS score of 1, the risk for constipation increased by 18% for every 10-point increase in the fatigue score.
The results overall indicate that the frequency of bladder and bowel problems in this Australian study group “is comparable to those reported in other states of Australia, and in other parts of the world,” the researchers said.
“Notably, this study also presents new information about the correlation between bladder/bowel function and fatigue in people with MS, which has not been previously highlighted in the literature,” they said.
The investigators said further research in this area is needed to explore the cause-and-effect relationship between these MS symptoms.
“Our preliminary findings suggest that there is an increasing need for a multimodal approach to the treatment of MS, given the interconnectivity of various MS symptoms,” they added.
According to the team, “further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies.”
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